Diabetes Mellitus Flashcards
What is diabetes mellitus?
It refers to a group of metabolic diseases characterised by hyperglycaemia due to insulin insensitivity or decreased insulin secretion
What is pre-diabetes?
A condition in which individuals have a raised blood glucose level, however this level is not considered high enough to be classified as diabetes
What is the pathophysiological consequence of pre diabetes?
These individuals have an increased risk of developing future diabetes and its associated complications
What are the two classifications of pre-diabetes?
Impaired Fasting Glucose (IFG) Prediabetes
Impaired Glucose Tolerance (IGT) Prediabetes
What is impaired fasting glucose pre diabetes?
It is is related to hepatic insulin resistance
What investigation result indicates impaired fasting glucose pre-diabetes?
A fasting glucose level between 6.1 mmol/l – 7 mmol/l
What is impaired glucose tolerance pre-diabetes?
It is is related to muscle insulin resistance
Which pre-diabetes classification has a an increased risk of future type two diabetes mellitus development and cardiovascular disease?
Impaired glucose tolerance pre-diabetes
What investigation result indicates impaired tolerance glucose pre-diabetes?
A fasting plasma glucose level < 7mmol/l
AND
An oral glucose tolerance test 2-hour level between 7.8mmol/l and 11.1 mmol/l
What are the five risk factors associated with pre-diabetes?
Older Age > 45
Black, Chinese, South Asian Ethnicity
Family History
Central Obesity, BMI > 30
Reduced Physical Activity
What are the three investigations used to diagnose pre-diabetes?
HbA1C Test
Fasting Blood Glucose Test
Oral Glucose Tolerance Test (OGTT)
What is the HbA1C test?
It measures the quantity of glucose bound to haemoglobin
What information does a HbA1c test provide? How?
It indicates an average glucose levels for the past two to three months
This is due to the fact that glucose permanently binds to haemoglobin, which last up to a period of three months
What HbA1c test result indicates pre-diabetes?
5.7% to 6.4% (42mmol/mol – 48mmol/mol)
In which five circumstances can a HbA1c test not be used to diagnose pre-diabetes?
Children
Pregnant Patients
HIV Patients
Pancreatic Disease Patients
Patients with A Short Duration of Diabetes Symptoms
How long after pregnancy is a HbA1c test no longer contraindicated?
> 2 Months
What is a fasting blood glucose test?
It involves taking a blood sample after an individual has fasted overnight.
What fasting blood glucose result indicates pre-diabetes?
Between 6.1mmol/L – 6.9mmol/L
What pre-diabetes classification is indicated by an abnormal fasting blood glucose result?
Impaired fasting glucose prediabetes
What is an oral glucose tolerance test (OGTT)?
It involves taking a patient’s baseline fasting plasma glucose, giving them a 75g glucose drink and then measuring their plasma glucose two hours later
What oral glucose tolerance test result indicates pre-diabetes?
Between 7.8mmol/L – 11.1mmol/L
What pre-diabetes classification is indicated by an abnormal oral glucose tolerance test result?
Impaired glucose tolerance prediabetes
How do we manage pre-diabetes?
Conservative management
What are the four conservative management options of pre diabetes?
Weight Loss
Increased Exercise
Dietary Changes
Annual Follow-Up Blood Tests
When is metformin recommended to manage prediabetes?
It is recommended that individuals who are still progressing towards type two diabetes mellitus, despite their participation in an intensive lifestyle-change programme
What is gestational diabetes?
It is a condition in which high blood glucose levels occur for the first-time during pregnancy
In which two trimesters does gestation diabetes tend to occur?
Second
Third
What are the five risk factors of gestational diabetes?
Black, Chinese, South Asian Ethnicity
Obesity, BMI > 30
Previous Macrosomic Baby > 4.5kg
Previous Gestational Diabetes
First Degree Family History of Diabetes
During antenatal screening what is the most appropriate management option following urinalysis glucose trace results? Why?
Reassurance and safety net
This is due to the fact that this is normal in pregnancy due to the increased GFR and reduction in tubular reabsorption of filtered glucose
What is the gold standard investigation used to diagnose gestational diabetes?
Oral Glucose Tolerance Test (OGTT)
In which two circumstances do we screen for gestational diabetes with an OGTT?
Previous Gestational Diabetes
Gestational Diabetes Risk Factors
When do we conduct an OGTT in pregnant patients, who have had previous gestational diabetes?
As soon as possible after the booking date
AND
Between 24 – 28 weeks’ gestation, if the first test is normal
When do we conduct an OGTT in pregnant patients, who have gestational diabetes risk factors?
Between 24 – 28 weeks’ gestation
What OGTT result indicates gestational diabetes?
A fasting glucose > 5.6 mmol/l
OR
A 2-hour glucose > 7.8 mmol/l
‘5678’
What are the four conservative management options of gestational diabetes?
Weekly Antenatal & Diabetic Clinics
Blood Glucose Self-Monitoring
Diet Advice
Exercise Advice
What are the three pharmacological management options of gestational diabetes?
Metformin
Insulin
Glibenclamide
What is the management option of gestational diabetes, in patients with a fasting plasma glucose < 7?
A trial of diet and exercise should be offered
In cases where glucose targets are not obtained within 1-2 weeks, metformin should then be commenced
If glucose targets are still not met, insulin should be added
In which circumstance do we treat gestational diabetes, in patients with a fasting plasma glucose < 7, with insulin?
In cases where there is evidence of complication development
What is the management option of gestational diabetes, in patients with a fasting plasma glucose > 7?
Insulin
When is glibenclamide used to manage gestational diabetes?
It should only be offered for women who cannot tolerate metformin
OR
It should be offered to those who fail to meet the glucose targets with metformin but decline insulin treatment
What is the target fasting glucose level in gestational diabetes?
5.3 mmol/l
What is the target glucose level 1 hour > meals in gestational diabetes?
7.8 mmol/l
What is the target glucose level 2 hour > meals in gestational diabetes?
6.4 mmol/l
How do we manage diabetic patients who go into premature labour?
Admit
x2 IM steroids
Monitor blood glucose levels closely
What is a marker for early labour?
Fetal Fibronectin (fFN)
What are the five fetal complications of gestational diabetes?
Macrosomia > 9 Pounds
Respiratory Distress Syndrome
Surfactant Deficient Lung Disease
Neonatal Hypoglycaemia
Future Type Two Diabetes
How do we manage neonatal hypoglycaemia, which is asymptomatic?
Normal feeding
Monitor blood glucose
How do we manage neonatal hypoglycaemia, which is symptomatic or severely low?
Admit to neonatal unit
IV 10% dextrose
What are the three maternal complications of gestational diabetes?
Future Gestational Diabetes
Future Diabetes Mellitus
Hypertension
How often do we advise type one diabetes to check their blood glucose levels throughout their pregnancy?
Daily Fasting
Pre-Meal
1-Hour Post-Meal
Bedtime
What does MODY stand for?
Maturity onset diabetes of the young
What is MODY?
It is a genetic condition, in which there is impairment of pancreatic beta-cell function and therefore insulin synthesis
What is the inheritance of MODY?
Autosomal dominant
What are the two classifications of MODY?
Glucokinase MODY
Transcription Factor MODY
What is glucokinase?
A gene involved in recognising how high blood glucose levels are
What is glucokinase MODY?
It is a defect within the glucokinase gene, which results in the body allowing blood glucose levels to rise slightly above normal, generally between 5.5 mmol/l – 8mmol/l
How does glucokinase MODY present?
Asymptomatically
How do we diagnose glucokinase MODY?
It is usually identified incidentally via routine resting during pregnancy
Do we treat glucokinase MODY? Why?
No
There is a rare chance of complication development
What is transcription factor MODY?
A defect within the transcription factor gene, in which the amount of insulin secreted by the pancreas is reduced and the hyperglycaemia is progressive
What are the three classifications of transcription factor MODY?
HNF-1α
HNF1β
HNF4 α
Do we treat transcription factor MODY? Why?
Yes
There is a high risk of complication development
What are the three treatment options of transcription factor MODY?
Dietary adjustments
Oral hypoglycaemic agents
Insulin injections
What is latent autoimmune diabetes of adults (LADA)?
It is an autoimmune related diabetes
When does LADA tend to present?
Young age
However, there are a small group of patients who present later in life
What is secondary diabetes?
It is diabetes that results as a consequence of another medical condition
What seven conditions are associated with secondary diabetes?
Cystic Fibrosis
Hemochromatosis
Chronic Pancreatitis
Pancreatectomy
Cushing’s Syndrome
Acromegaly
Phaeochromocytoma
